Provider Demographics
NPI:1144498494
Name:SIMPSON, LORA M (RD)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:M
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N OAK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2435
Mailing Address - Country:US
Mailing Address - Phone:931-520-7747
Mailing Address - Fax:931-520-7630
Practice Address - Street 1:127 N OAK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2435
Practice Address - Country:US
Practice Address - Phone:931-520-7747
Practice Address - Fax:931-520-7630
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN806994133V00000X
TN928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3241655Medicare PIN